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Gerontological Nursing Certification Examination practice questions

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Question 1Assessment and Management of the Older Adult

Which screening instrument is most appropriate for a brief cognitive assessment of an older adult in a primary care setting?

  1. CAGE questionnaire
  2. Mini-Cog Correct answer.
  3. Braden Scale
  4. PHQ-9

Explanation

The Mini-Cog is a brief, validated cognitive screen combining a three-item recall with a clock-drawing task and performs well in primary care. It is quick to administer and less affected by education and language than longer instruments.

Question 2Assessment and Management of the Older Adult

An older adult reports two falls in the past year. Which initial step best addresses fall risk during the visit?

  1. Advise limiting all physical activity to prevent falls
  2. Recommend a walking cane without further evaluation
  3. Order a brain MRI before any other action
  4. Perform a multifactorial fall risk assessment Correct answer.

Explanation

Guidelines recommend a multifactorial assessment after a fall or recurrent falls, covering gait, strength, vision, medications, home hazards, and orthostatic blood pressure. This structured approach identifies modifiable contributors.

Question 3Assessment and Management of the Older Adult

Which finding on the Timed Up and Go test is generally considered to indicate increased fall risk in community-dwelling older adults?

  1. Inability to complete the test without shoes
  2. A completion time under 5 seconds
  3. A completion time exactly equal to the patient's age in seconds
  4. A completion time of 12 seconds or longer Correct answer.

Explanation

A Timed Up and Go time of roughly 12 seconds or more is commonly used as a threshold suggesting increased fall risk in community-dwelling older adults. Shorter times generally indicate better mobility and lower risk.

Question 4Assessment and Management of the Older Adult

An 82-year-old has a blood pressure of 138/74 mmHg while seated and 112/68 mmHg after standing for one minute, with dizziness. What does this finding most likely represent?

  1. Resistant hypertension
  2. Orthostatic hypotension Correct answer.
  3. White coat hypertension
  4. Hypertensive urgency

Explanation

A drop of at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing defines orthostatic hypotension. The associated dizziness supports a symptomatic postural drop.

Question 5Assessment and Management of the Older Adult

Which medication class is most strongly associated with anticholinergic burden and should be reviewed carefully in older adults with cognitive impairment?

  1. Inhaled corticosteroids
  2. Loop diuretics
  3. Strong anticholinergics such as diphenhydramine Correct answer.
  4. Angiotensin-converting enzyme inhibitors

Explanation

Strongly anticholinergic drugs, including first-generation antihistamines like diphenhydramine, can worsen cognition, cause delirium, and contribute to falls and urinary retention. Deprescribing or substituting safer alternatives is a core geriatric principle.

Question 6Assessment and Management of the Older Adult

Which tool is designed specifically to identify potentially inappropriate medications in older adults?

  1. Glasgow Coma Scale
  2. CHA2DS2-VASc score
  3. Beers Criteria Correct answer.
  4. Wells score

Explanation

The Beers Criteria list medications whose risks generally outweigh benefits in older adults and are widely used to guide safer prescribing. The other tools assess thrombosis, stroke risk in atrial fibrillation, and level of consciousness.

Question 7Assessment and Management of the Older Adult

An older adult with mild cognitive impairment is being discharged on a new complex medication regimen. Which intervention best supports medication adherence?

  1. Increasing the number of daily doses to spread them out
  2. Discontinuing all chronic medications to reduce pill burden
  3. Relying on the patient to remember instructions from the visit
  4. Providing a simplified dosing schedule with a pill organizer and teach-back Correct answer.

Explanation

Simplifying regimens and using adherence aids such as pill organizers, combined with teach-back to confirm understanding, improve adherence. Teach-back verifies comprehension rather than assuming it.

Question 8Assessment and Management of the Older Adult

Which presentation of depression is more common in older adults than in younger adults?

  1. Prominent psychomotor agitation with pressured speech
  2. Early-onset dysthymia with substance misuse
  3. Predominant somatic complaints and less reported sadness Correct answer.
  4. Classic melancholia with guilt delusions

Explanation

Older adults with depression often present with somatic symptoms, fatigue, sleep disturbance, and cognitive complaints rather than reporting sadness directly. This atypical presentation can delay recognition.

Question 9Assessment and Management of the Older Adult

Which screening tool is validated for detecting depression in older adults and avoids reliance on somatic items that may reflect medical illness?

  1. Geriatric Depression Scale Correct answer.
  2. Katz Index of Independence
  3. Morse Fall Scale
  4. Mini-Mental State Examination

Explanation

The Geriatric Depression Scale was designed for older adults and uses a yes/no format that minimizes somatic items confounded by physical illness. The other tools assess cognition, function, and fall risk.

Question 10Assessment and Management of the Older Adult

An older adult with dementia becomes acutely confused, agitated, and inattentive over one day after starting a new sedative. What is the most likely diagnosis?

  1. Major neurocognitive disorder
  2. Delirium Correct answer.
  3. Sundowning unrelated to illness
  4. Late-life depression

Explanation

Acute onset, fluctuating course, and inattention are hallmarks of delirium, often triggered by medications or acute illness. Delirium is a medical emergency that requires identifying and treating the underlying cause.

Question 11Assessment and Management of the Older Adult

Which nonpharmacologic intervention is first-line for managing behavioral symptoms of dementia such as agitation?

  1. Identifying triggers and modifying the environment Correct answer.
  2. Physical restraint use during episodes
  3. Scheduled benzodiazepines for sleep
  4. Immediate initiation of an antipsychotic

Explanation

Nonpharmacologic approaches that identify triggers and modify the environment, routines, and caregiver interactions are first-line for behavioral symptoms of dementia. Antipsychotics carry increased mortality risk in this population and are reserved for severe distress or danger.

Question 12Assessment and Management of the Older Adult

Which change in an older adult most strongly suggests the need to evaluate for urinary tract infection rather than attributing symptoms to normal aging?

  1. Gradual decline in hearing over years
  2. New-onset confusion with urinary frequency and urgency Correct answer.
  3. Slowly progressive knee stiffness
  4. Gradual thinning of hair

Explanation

Acute confusion combined with urinary symptoms can indicate infection, and acute change in mental status warrants evaluation for a reversible cause. Gradual sensory or musculoskeletal changes are more consistent with chronic aging processes.

Question 13Assessment and Management of the Older Adult

An older adult has an estimated creatinine clearance of 35 mL/min. What is the most appropriate prescribing principle?

  1. Adjust renally cleared medications to the reduced clearance Correct answer.
  2. Double the dose to overcome reduced absorption
  3. Use standard adult doses because age does not affect dosing
  4. Avoid all medications regardless of indication

Explanation

Reduced kidney function requires dose adjustment of renally cleared drugs to avoid toxicity. Estimating clearance and adjusting doses is a core prescribing principle in older adults.

Question 14Assessment and Management of the Older Adult

Which finding is most consistent with normal age-related change rather than disease?

  1. Gradual loss of high-frequency hearing Correct answer.
  2. Acute onset of severe chest pain
  3. Sudden inability to speak
  4. A new focal neurologic deficit

Explanation

Presbycusis, the gradual loss of high-frequency hearing, is a common normal age-related change. Acute focal neurologic findings or sudden severe pain suggest disease requiring urgent evaluation.

Question 15Assessment and Management of the Older Adult

Which nutritional concern is especially important to screen for in community-dwelling older adults?

  1. Overconsumption of dietary fiber
  2. Unintentional weight loss and malnutrition Correct answer.
  3. Excess protein intake
  4. Excessive hydration

Explanation

Unintentional weight loss and malnutrition are common in older adults and contribute to frailty, impaired immunity, and functional decline. Routine screening with a validated tool such as the Mini Nutritional Assessment helps identify risk.

Question 16Assessment and Management of the Older Adult

An older adult with a body mass index of 21 kg/m2 and a 5 kg weight loss over six months reports poor appetite. Which action is most appropriate?

  1. Reassure the patient that weight loss is expected with aging
  2. Start a stimulant laxative to improve appetite
  3. Recommend a restrictive weight-loss diet
  4. Assess for reversible causes and consider high-protein supplementation Correct answer.

Explanation

Clinically significant unintentional weight loss warrants evaluation for reversible causes such as depression, medication effects, dental problems, and malignancy. High-protein supplementation and dietary support help address malnutrition.

Question 17Assessment and Management of the Older Adult

Which intervention best reduces the risk of pressure injury in an older adult with limited mobility?

  1. Applying alcohol-based lotion to bony prominences
  2. Restricting fluid intake to reduce moisture
  3. Repositioning on a scheduled interval and using pressure-redistribution surfaces Correct answer.
  4. Maintaining the head of the bed elevated at 45 degrees continuously

Explanation

Scheduled repositioning and pressure-redistribution surfaces reduce sustained pressure over bony prominences, which is central to pressure injury prevention. Skin assessment and moisture management are also important.

Question 18Assessment and Management of the Older Adult

Which statement best describes the purpose of advance care planning in the care of older adults?

  1. It replaces the need for a health care proxy
  2. It transfers all decision-making authority to the clinician
  3. It documents the patient's values and preferences to guide future care Correct answer.
  4. It guarantees that heroic measures will be used

Explanation

Advance care planning elicits and documents a patient's values, goals, and treatment preferences so care can be aligned if the patient loses decision-making capacity. It supports, but does not replace, a health care proxy.

Question 19Assessment and Management of the Older Adult

An 85-year-old with advanced dementia, recurrent aspiration pneumonia, and poor oral intake is being considered for percutaneous feeding tube placement. What is the most appropriate counseling point?

  1. Tube feeding eliminates the need for oral care
  2. Tube feeding has not been shown to prolong survival or improve quality of life in advanced dementia Correct answer.
  3. Tube feeding restores independent eating
  4. Tube feeding reliably prevents aspiration pneumonia

Explanation

Evidence does not show that feeding tubes prolong survival or improve quality of life in advanced dementia, and they do not reliably prevent aspiration. Goals-of-care discussions should guide decisions, with hand feeding often preferred.

Question 20Assessment and Management of the Older Adult

Which factor most increases an older adult's risk of adverse drug events?

  1. Taking multiple medications with altered pharmacokinetics Correct answer.
  2. Regular physical activity
  3. A single prescription for a topical emollient
  4. Living in a private residence

Explanation

Polypharmacy combined with age-related changes in drug metabolism and clearance increases the risk of adverse drug events. Regular review and deprescribing reduce this risk.

Question 21Assessment and Management of the Older Adult

An older adult with diabetes has an HbA1c of 9.0% and experiences frequent hypoglycemia. What is the most appropriate management approach?

  1. Encourage skipping meals to lower glucose
  2. Intensify therapy to achieve an HbA1c below 6.5%
  3. Set a less stringent glycemic target and reduce hypoglycemia risk Correct answer.
  4. Add a sulfonylurea to improve control

Explanation

In older adults with hypoglycemia and comorbidity, less stringent glycemic targets reduce the risk of severe hypoglycemia, which can cause falls, confusion, and cardiovascular events. Individualized goals balance benefit and harm.

Question 22Assessment and Management of the Older Adult

Which immunization is specifically recommended for older adults to reduce the risk of severe respiratory disease and is typically given as a single dose in this age group?

  1. Influenza vaccine
  2. Pneumococcal vaccine Correct answer.
  3. Yellow fever vaccine
  4. Hepatitis B vaccine

Explanation

Pneumococcal vaccination is recommended for older adults to reduce invasive pneumococcal disease and is given according to age-based schedules. Influenza vaccine is recommended annually rather than as a one-time dose.

Question 23Assessment and Management of the Older Adult

An older adult reports nocturia, urinary urgency, and a feeling of incomplete emptying. Which assessment is most important to obtain first?

  1. A detailed medication and fluid intake history Correct answer.
  2. A routine chest radiograph
  3. A skin allergy panel
  4. An immediate referral for surgery

Explanation

Urinary symptoms in older adults are often multifactorial, with medications, diuretics, caffeine, and fluid timing contributing to nocturia and urgency. A thorough history guides nonpharmacologic and pharmacologic management.

Question 24Assessment and Management of the Older Adult

Which finding most strongly suggests that an older adult's memory complaints are due to a neurodegenerative process rather than normal aging?

  1. Forgetting a name and recalling it later
  2. Occasionally misplacing keys
  3. Slower processing speed during complex tasks
  4. Progressive decline in instrumental activities of daily living Correct answer.

Explanation

Progressive decline in instrumental activities of daily living, such as managing finances or medications, suggests a neurodegenerative process rather than normal aging. Occasional forgetfulness with later recall is typical of normal aging.

Question 25Assessment and Management of the Older Adult

Which intervention best supports an older adult with hearing loss during a clinical encounter?

  1. Covering the mouth while speaking
  2. Shouting from another room
  3. Speaking rapidly to save time
  4. Facing the patient, speaking clearly, and reducing background noise Correct answer.

Explanation

Facing the patient, speaking clearly at a moderate pace, and reducing background noise improve communication for people with hearing loss. Visual cues and amplification further support understanding.

Question 26Assessment and Management of the Older Adult

Which component is essential to include in a comprehensive geriatric assessment (CGA) but is often omitted in a standard adult history and physical?

  1. Measurement of serum electrolytes and renal function
  2. Review of current medications and allergies
  3. Auscultation of the heart and lungs
  4. Assessment of functional status and activities of daily living Correct answer.

Explanation

A CGA is multidimensional and specifically evaluates functional ability, cognition, nutrition, and social support, which are not routine in a standard adult examination. Laboratory tests, cardiac auscultation, and medication review are standard components of general adult care but do not define the geriatric assessment.

Question 27Assessment and Management of the Older Adult

An older adult reports difficulty with instrumental activities of daily living (IADLs). Which task is an example of an IADL?

  1. Bathing independently
  2. Transferring from bed to chair
  3. Managing finances and paying bills Correct answer.
  4. Eating without assistance

Explanation

IADLs are higher-order tasks that require cognitive and organizational skills, such as managing money, shopping, and using transportation. Bathing, transferring, and eating are basic activities of daily living (ADLs) that reflect more fundamental self-care capacity.

Question 28Assessment and Management of the Older Adult

Which physiologic change of aging most directly increases the risk of dehydration in older adults?

  1. Decreased total body water and blunted thirst sensation Correct answer.
  2. Enhanced renal concentrating ability
  3. Increased cardiac output at rest
  4. Increased glomerular filtration rate

Explanation

Aging is associated with reduced total body water, diminished thirst perception, and impaired renal concentrating capacity, all of which predispose to dehydration. Glomerular filtration rate and cardiac output typically decline with age, and renal concentrating ability is impaired rather than enhanced.

Question 29Assessment and Management of the Older Adult

Which screening instrument is specifically designed to assess fall risk in community-dwelling older adults by measuring the time to rise from a chair, walk a short distance, and return?

  1. Braden Scale
  2. Timed Up and Go (TUG) test Correct answer.
  3. Mini-Cog
  4. Confusion Assessment Method (CAM)

Explanation

The Timed Up and Go test measures mobility and balance by timing a person as they stand, walk 3 meters, turn, and sit back down, and it is a validated fall-risk screen. The Mini-Cog assesses cognition, the Braden Scale assesses pressure injury risk, and the CAM detects delirium.

Question 30Assessment and Management of the Older Adult

An 82-year-old woman has a blood pressure of 158/72 mm Hg in the clinic and reports no symptoms. She has no diabetes or chronic kidney disease. According to current hypertension guidelines for older adults, what is the most appropriate next step?

  1. Reassure her that this blood pressure is normal for her age
  2. Initiate or adjust antihypertensive therapy to target a systolic pressure below 130 mm Hg Correct answer.
  3. Obtain ambulatory blood pressure monitoring before any change in therapy
  4. Discontinue any antihypertensive medication to avoid orthostasis

Explanation

Guidelines recommend treating hypertension in older adults to a systolic target of less than 130 mm Hg when tolerated, because intensive control reduces cardiovascular events. A systolic pressure of 158 mm Hg is not normal for age and warrants treatment rather than reassurance or discontinuation of therapy.

Question 31Assessment and Management of the Older Adult

An older adult with heart failure and a reduced ejection fraction has an eGFR of 28 mL/min/1.73 m2. Which prescribing consideration is most important when adding a new medication?

  1. Use standard adult doses because age-related changes are predictable
  2. Avoid all cardiovascular medications in chronic kidney disease
  3. Select renally cleared drugs cautiously and adjust doses for kidney function Correct answer.
  4. Increase the dose to compensate for reduced absorption

Explanation

Reduced kidney function impairs clearance of many drugs and their metabolites, so renally eliminated medications require dose adjustment to avoid toxicity. Standard adult dosing ignores this variability, avoiding all cardiovascular drugs is not appropriate, and increasing doses would worsen accumulation.

Question 32Assessment and Management of the Older Adult

An older adult is brought to the clinic by a caregiver who reports that the patient has become increasingly withdrawn, has lost interest in previously enjoyed activities, and has a flat affect. Which screening approach is most appropriate?

  1. Use a validated depression screening tool and obtain collateral information from the caregiver Correct answer.
  2. Rely on the patient's self-report of mood alone
  3. Order neuroimaging before any screening
  4. Assume the symptoms are due to normal aging and reassure the caregiver

Explanation

Older adults often present with atypical or somatic symptoms of depression and may underreport mood changes, so validated screening combined with caregiver input improves detection. Normalizing symptoms as aging delays diagnosis, and imaging is not the first step in screening for depression.

Question 33Assessment and Management of the Older Adult

An older adult with osteoarthritis reports chronic knee pain. Which pharmacologic strategy is preferred as initial management to reduce gastrointestinal and renal risk?

  1. Topical NSAID applied to the affected knee Correct answer.
  2. Scheduled oral ibuprofen at the maximum dose
  3. Meperidine for breakthrough pain
  4. Long-term oral corticosteroid therapy

Explanation

Topical NSAIDs provide local analgesia with much lower systemic exposure and are preferred for localized osteoarthritis in older adults at risk for gastrointestinal and renal adverse effects. Oral NSAIDs at maximum dose, chronic corticosteroids, and meperidine all carry substantial risk in this population.

Question 34Assessment and Management of the Older Adult

An older adult with type 2 diabetes has an HbA1c of 7.8%, no hypoglycemia, and a life expectancy of more than 10 years. Which glycemic target is most appropriate?

  1. Less than 8.0% Correct answer.
  2. Less than 7.0%
  3. Less than 6.0%
  4. Less than 9.0%

Explanation

For many older adults with good functional status and limited comorbidity, an HbA1c target of less than 8.0% balances benefits and hypoglycemia risk. Targets below 7.0% may be appropriate for healthier younger-old adults, while less than 9.0% is reserved for those with limited life expectancy or high hypoglycemia risk.

Question 35Assessment and Management of the Older Adult

An older adult is admitted with a hip fracture. Which intervention is most important to prevent delirium during hospitalization?

  1. Prescribe a benzodiazepine for sleep
  2. Restrict family visitation to reduce stimulation
  3. Maintain orientation, mobility, hydration, and sleep hygiene Correct answer.
  4. Use physical restraints to prevent falls

Explanation

Nonpharmacologic multicomponent interventions that preserve orientation, promote mobility, maintain hydration, and support sleep are the cornerstone of delirium prevention. Benzodiazepines, restraints, and reduced visitation all increase delirium risk.

Question 36Assessment and Management of the Older Adult

An older adult with advanced chronic obstructive pulmonary disease has a body mass index of 19 kg/m2 and unintentional weight loss. Which intervention is most appropriate?

  1. Recommend a low-calorie diet to prevent obesity
  2. Provide high-calorie, high-protein oral nutritional supplements and dietitian referral Correct answer.
  3. Encourage fluid restriction to reduce breathlessness
  4. Initiate appetite-suppressing medication

Explanation

Malnutrition and low body mass index worsen outcomes in chronic obstructive pulmonary disease, so high-calorie, high-protein supplementation with dietitian support is recommended. Low-calorie diets, fluid restriction, and appetite suppressants would further compromise nutritional status.

Question 37Assessment and Management of the Older Adult

An older adult with moderate dementia becomes agitated during evening care. Which initial approach is most appropriate?

  1. Apply physical restraints until the agitation resolves
  2. Identify and modify environmental triggers and use calm redirection Correct answer.
  3. Ignore the behavior to avoid reinforcing it
  4. Administer an antipsychotic medication

Explanation

Behavioral symptoms in dementia are often triggered by environmental factors, pain, or unmet needs, so the first step is to identify and modify triggers and use calm redirection. Antipsychotics, restraints, and ignoring the behavior carry risks and do not address the underlying cause.

Question 38Assessment and Management of the Older Adult

An older adult has a serum sodium of 128 mEq/L and is on a thiazide diuretic. Which action is most appropriate?

  1. Continue the thiazide and recheck sodium in one month
  2. Restrict free water intake without further evaluation
  3. Administer hypertonic saline immediately
  4. Discontinue the thiazide and evaluate the cause of hyponatremia Correct answer.

Explanation

Thiazide diuretics are a common cause of hyponatremia in older adults, and the appropriate step is to stop the offending agent and investigate the cause. Hypertonic saline is reserved for severe symptomatic hyponatremia, and simple water restriction without evaluation may be inadequate or unsafe.

Question 39Assessment and Management of the Older Adult

An older adult with atrial fibrillation is being considered for anticoagulation. Which factor is most important in deciding between a direct oral anticoagulant and warfarin?

  1. The patient's age alone
  2. The patient's preference for pill color
  3. The presence of hypertension
  4. Renal function and potential drug interactions Correct answer.

Explanation

Direct oral anticoagulants are renally cleared and interact with fewer drugs than warfarin, so renal function and interaction potential are key determinants of agent selection. Age alone, pill color preference, and hypertension do not determine the choice between anticoagulant classes.

Question 40Assessment and Management of the Older Adult

An 88-year-old man with mild cognitive impairment and no advance directive develops pneumonia and is unable to make decisions. His daughter is present and willing to serve as surrogate. What is the most appropriate next step?

  1. Ask the daughter to make decisions based on the patient's known values and preferences Correct answer.
  2. Proceed with treatment based solely on the physician's judgment
  3. Have the daughter sign a do-not-resuscitate order immediately
  4. Delay treatment until a court appoints a guardian

Explanation

When a patient lacks decision-making capacity, the appropriate surrogate should make decisions using substituted judgment based on the patient's values and previously expressed wishes. Proceeding without surrogate input, delaying for guardianship, or imposing a do-not-resuscitate order without discussion is inappropriate.

Question 41Health Promotion and Disease Prevention

Which screening test is recommended annually for adults aged 50 to 75 at average risk for colorectal cancer?

  1. High-sensitivity fecal occult blood test Correct answer.
  2. Flexible sigmoidoscopy every five years
  3. CT colonography every five years
  4. Colonoscopy every ten years

Explanation

Guidelines list several acceptable strategies, and a high-sensitivity stool-based test is recommended annually, while colonoscopy is recommended every ten years and sigmoidoscopy or CT colonography every five years. The interval distinguishes the stool test as the annual option.

Question 42Health Promotion and Disease Prevention

A 68-year-old woman with no history of fracture has a bone mineral density T-score of -2.8 at the femoral neck. Which recommendation is most appropriate?

  1. Begin pharmacologic therapy for osteoporosis Correct answer.
  2. Start calcium alone and reassess in one year
  3. Refer only for physical therapy for balance
  4. Repeat the scan in two years without treatment

Explanation

A T-score of -2.5 or lower at the hip or spine meets the densitometric definition of osteoporosis, which warrants pharmacologic treatment in addition to adequate calcium and vitamin D. Calcium alone does not treat established osteoporosis.

Question 43Health Promotion and Disease Prevention

At what age does the Advisory Committee on Immunization Practices recommend routine annual influenza vaccination begin for all persons without contraindication?

  1. 5 years of age
  2. 2 years of age
  3. 6 months of age Correct answer.
  4. 12 months of age

Explanation

Annual influenza vaccination is recommended for everyone aged 6 months and older who has no contraindication, so 6 months is the correct starting point.

Question 44Health Promotion and Disease Prevention

Which vaccine is specifically recommended for adults aged 60 and older to prevent herpes zoster and its complications?

  1. Hepatitis B vaccine
  2. Recombinant zoster vaccine Correct answer.
  3. Pneumococcal conjugate vaccine
  4. Tetanus-diphtheria booster

Explanation

The recombinant zoster vaccine is recommended for adults aged 50 and older, including those 60 and older, to prevent shingles and postherpetic neuralgia. The other vaccines target different pathogens.

Question 45Health Promotion and Disease Prevention

An older adult reports drinking one to two glasses of wine most evenings and asks about alcohol limits. Which counseling is most consistent with healthy aging guidance?

  1. Moderate drinking is defined as up to one drink per day for older women and up to two for older men Correct answer.
  2. Alcohol is safe only if consumed with a full meal
  3. Any alcohol use should be avoided entirely at every age
  4. Older adults may drink without limits because tolerance changes with age

Explanation

Moderate drinking is generally defined as up to one drink per day for women and up to two per day for men, and older adults often have lower tolerance due to body composition and medication interactions. Complete abstinence is not universally required, and no-meal or unlimited use is not supported.

Question 46Health Promotion and Disease Prevention

Which behavior is the single most effective primary prevention measure to reduce skin cancer risk in older adults?

  1. Daily vitamin D supplementation
  2. Annual total-body skin examination
  3. Use of tanning beds in moderation
  4. Regular use of broad-spectrum sunscreen and sun avoidance Correct answer.

Explanation

Limiting ultraviolet exposure through sunscreen and avoiding peak sun is the primary prevention strategy for skin cancer. Screening examinations detect but do not prevent cancer, and tanning beds increase risk.

Question 47Health Promotion and Disease Prevention

A 72-year-old man has a 30 pack-year smoking history and currently smokes. Which lung cancer screening approach is recommended?

  1. Annual low-dose CT scan of the chest Correct answer.
  2. Annual chest radiograph
  3. Sputum cytology every two years
  4. No screening because of his age

Explanation

Annual low-dose computed tomography is recommended for adults aged 50 to 80 with a significant smoking history who currently smoke or quit within the past 15 years. Chest radiography and sputum cytology are not recommended screening tools.

Question 48Health Promotion and Disease Prevention

Which dietary pattern is most strongly associated with reduced cardiovascular risk in older adults?

  1. A diet emphasizing whole milk and butter
  2. High intake of processed meats and refined grains
  3. A Mediterranean-style pattern rich in vegetables, fruits, legumes, and unsaturated fats Correct answer.
  4. A diet relying primarily on supplements rather than food

Explanation

A Mediterranean-style eating pattern emphasizing plant foods, legumes, and unsaturated fats is associated with lower cardiovascular risk. Processed meats, high saturated fat, and supplement-only approaches are not supported.

Question 49Health Promotion and Disease Prevention

Which physical activity recommendation applies to generally healthy older adults?

  1. At least 150 minutes of moderate-intensity aerobic activity weekly plus muscle-strengthening twice weekly Correct answer.
  2. Strength training only, with no aerobic component
  3. No structured exercise unless supervised by a physician
  4. Vigorous aerobic exercise only, five days per week

Explanation

Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity per week plus muscle-strengthening activities on two or more days. Balance training is also advised for older adults at fall risk.

Question 50Health Promotion and Disease Prevention

A community program aims to reduce falls among older adults. Which intervention has the strongest evidence for preventing falls in this population?

  1. Prescribing bed rest for those with prior falls
  2. Routine use of sedative medications to improve sleep
  3. Encouraging older adults to avoid all walking outdoors
  4. Home safety modification combined with a structured exercise program Correct answer.

Explanation

Multifactorial interventions that combine exercise with home hazard reduction have the strongest evidence for fall prevention. Bed rest, sedatives, and activity restriction increase rather than decrease fall risk.